Management of postpartum hemorrhage in the emergency department

Case

It has been a busy day in your emergency department. The precipitous delivery that occurred at triage was complicated by shoulder dystocia. Luckily you had some help, and one of your colleagues is managing the neonatal resuscitation. Nurses are starting to congratulate mom and pat you on the back, when a senior nurse points out that the patient looks pretty pale. You glance at the monitor and notice a heart rate of 145 and only then do you notice that she is bleeding… a lot…

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Cardiac arrest in pregnancy: the perimortem cesarean section

A simplified approach to the initial emergency department assessment and management of pregnant patients in cardiac arrest

Case

The bat phone rings, and through the static of the EMS patch, you hear that they are 2 minutes out with a 36-year-old woman in PEA, but you couldn’t hear that last bit. After 3 more attempts (maybe you were in denial) you finally hear the word “pregnant” and now they are rolling through your doors…

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The Difficult Delivery: Umbilical Cord Prolapse

A simplified approach to the initial assessment and management of emergency department patients with umbilical cord prolapse

Case

Once again, a 34 year old G5P4 woman at 39 weeks gestation is wheeled into your resus room in what appears to be precipitous delivery. You perform a quick exam, but instead of encountering the presenting part, you feel a pulsatile cord. Oh no, you remember hearing about umbilical cord prolapse back in medical school…

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The Difficult Delivery: Breech Presentation

A simplified approach to the breech delivery in the emergency department

Case

A 34 year old woman G5P4 at 39 weeks gestation is wheeled into your department, and your nurses tell you to get ready: she is crowning! You examine the patient, and sure enough she appears to be crowning, but something looks funny. That is a weird looking head. Oh wait, its a bum!

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The Difficult Delivery: Shoulder Dystocia

A simplified approach to the shoulder dystocia in the emergency department

Case

You are proceeding with the precipitous delivery described in the previous post. You have just delivered the head, but it seems to pull back. No further progress is being made. As you stare down at the head, you swear it reminds you of some kind of animal – oh right, a turtle! This is shoulder dystocia…

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Precipitous delivery in the ED

A simplified approach to precipitous delivery in the emergency department

Case

You are chatting with your triage nurses on a slow night shift when a car pulls up to the front doors. A 34 year old woman G5P4 at 39 weeks gestation is wheeled up to triage by a slightly panicked appearing boyfriend. Her waters broke in the car on the way in and she feels the need to push. A quick exam after you get her through the doors reveals that she is crowning.

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